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208164 04/24/2012 CITY OF CARMEL, INDIANA VENDOR: 146500 Page 1 of 1 ONE CIVIC SQUARE INDIANA DEPT OF WORKFORCE CARMEL, INDIANA 46032 DEVELOPMENT ATTN: ACCT RECV CHECK AMOUNT: $982.54 101 N SENATE AVE CHECK NUMBER: 208164 INDIANAPOLIS IN 46206 -0847 CHECK DATE: 4/24/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 R4110000 30305 676277 982.54 UNEMPLOYMENT 676277 -1 INDIANA DEPARTMENT OF WORKFORCE DEVELOPMENT BENEFIT ADMINISTRATION, 10 NORTH SENATE AVENUE, INDIANAPOLIS, IN 46204 -2277 Toll free 1- 800 891 -6499 Marion County 232 -7436 STATEMENT OF BENEFIT CHARGES (FORM 535) CONFIDENTIAL RECORD PURSUANT TO IC 22- 4 -19 -6, IC 4 -1 -66 Page 1 CARMEL CLAY BOARD OF PARKS ACCOUNT/ AND RECREATION LOCATION NUMBER 676277 -000 1 411 E 116TH ST REPORTING MONTH MAR, 2012 CARMEL IN 46032 3455 NETCHARGES $982.54 POSTING DATE APR 06, 2012 The receipt of this statement (Form 535) does not reopen the question of the claimant's eligibility for unemployment insurance since, before any payments were made the employer had the opportunity and the responsibility to report any information which could disqualify the claimant. SOCIAL BENEFIT PAID FOR SECURITY YEAR END I CLAIM TRANSACTION WEEK AMOUNT NUMBER EMPLOYEE'S NAME DATE LEVEL DATE I ENDING A CHARGED THIS IS NOT A BILL OR A REQUEST FOR MONEY DUE TO THIS DEPARTMENT. It is a statement of benefit charges made to your account during the "reporting" month. At the end of the "posting" month, you will receive a Reimbursable Bill (Form 1067) for these charges and any previous liability still outstanding. NEW CHARGES FOR THE REPORTING MONTH 03/12 N R GREEN 01/19/13 REG 03/22/12 03/17/12 183.00 TOTAL NEW CHARGES FOR THE REPORTING MONTH 03/12 982.54 TOTAL AMOUNT OF NET CHARGES 982.54 END OF BENEFIT CHARGE STATEMENT Purchase ?O 4 Aiak '1X De Tr Description �3d5 r F C7� P.O. f /25- ld OOD ©2011 G.L. et jda ult'�i 2��U,La,►� Line L7ascr V BY purchaser_ Date p.,pp. vat Date_ 0 An in the ACQ column denotes a charge resulting from an acquisition of another business. ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by whom, rates per day, number.of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. 146500 Indiana Dept. of Workforce Development Terms 10 North Senate Ave., SE 106 Date Due Indianapolis, IN 46204 -2277 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 4/6/12 676277 Unemployment charges Parks Acct Mar'12 30305 982.54 Total 982.54 1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6 20_ Clerk- Treasurer Voucher No. Warrant No. 146500 Indiana Dept. of Workforce Development Allowed 20 10 North Senate Ave., SE106 Indianapolis, IN 46204 -2277 In Sum of 982.54 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT AMOUNT Board Members Dept TITLE 30305 676277 4110000 982.54 1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 19 -Apr 2012 Signature 982.54 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund